Tinnitus is not categorically a condition but a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder. Tinnitus involves the sensation of hearing sound when no external sound is present. Tinnitus symptoms may include these types of phantom noises in your ears such as ringing, buzzing, roaring, buzzing, clicking, hissing or humming. The most common type of this is subjective tinnitus which is the kind the veteran can only hear.

If you have experienced any symptoms of tinnitus since your time in service, you deserve to be rated for it. Many who experience tinnitus don’t even bother to file a claim because they might believe it’s not serious enough for them to worry about. That’s just leaving money on the table! As a veteran, you are entitled to these benefits, and there is no reason to avoid receiving what is owed you. Receiving a rating can make it easier to get benefits later if you ever begin to develop hearing loss.

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/2fb1f403-3f7f-4d66-a339-cf67e8d21d8b/Secondary_Conditions.gif" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/2fb1f403-3f7f-4d66-a339-cf67e8d21d8b/Secondary_Conditions.gif" width="40px" /> Getting Tinnitus Service-Connected Secondary to Another Condition: People most at risk of tinnitus are those who work in loud conditions including musicians, elderly and the military personnel. If you’re thinking about filing your tinnitus claim as a secondary disability, the following service-connected conditions can cause or make tinnitus worse:

• Head and Neck Injuries
• Meniere’s Disease
• Depression/Anxiety/PTSD
• Traumatic Brain Injury (TBI)
• Hearing Loss
• Temporomandibular Joint Disorder (TMD)
• High Blood Pressure (Hypertension)
• Vertigo

Already Service-Connected for Tinnitus:

If you are already service-connected for tinnitus, the following conditions may be claimed as secondary:

• Migraines
• Meniere’s Syndrome
• Vertigo
• Mental Health (anxiety or depression) </aside>

Diagnosing Tinnitus

Tinnitus - Delayed Onset

Tinnitus Triggers

Nexus Opinions Not Required for Tinnitus

<aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/bdc05387-fb61-4e71-a8c6-c5376b787d0c/Attacking_Comp_and_Pen_Exam.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/bdc05387-fb61-4e71-a8c6-c5376b787d0c/Attacking_Comp_and_Pen_Exam.png" width="40px" /> Reviewing Tinnitus Denials

What to Do When the VA Denies Service-Connection for Tinnitus:

Step 1 - pull up the veteran's DD-214 and make a note of his/her MOS (especially if there are multiple). Is the MOS associated with a moderate or high probability of noise exposure?

• Yes - appeal in HLR and ask for service-connection (cite to M21-1MR below):

  <aside> <img src="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/c897ec77-d6ba-4c5e-9bb3-b912c0dd0358/M21-1MR_Bible.png" alt="https://s3-us-west-2.amazonaws.com/secure.notion-static.com/c897ec77-d6ba-4c5e-9bb3-b912c0dd0358/M21-1MR_Bible.png" width="40px" /> When evaluating hearing loss and tinnitus claims, the VA must review the veteran’s military occupational specialty (MOS) or Air Force Specialty Code (AFSC) in the Duty MOS Noise Exposure Listing to determine the probability of exposure to hazardous noise during the veteran’s service. See VA Adjudication Manual, M21-1MR, Part III, Subpart iv, Chapter 4, Section B, Subsection 4(e) (September 29, 2017). If the duty position is shown to have a high, moderate, or low probability of hazardous noise exposure, concede exposure to hazardous noise for the purposes of establishing an event in service. Id.

  </aside>

• No - are there multiple MOSs? If no, file SUPP with research noise exposures for this MOS and submit some research articles about this MOS to establish that the veteran was in fact exposed to loud noises consistently throughout service

Step 2 - pull the most recent RD Code Sheet. Is the veteran service-connected for hearing loss?

• Yes - file NOD Direct

• No - file HLR - DTA Error (Inadequate Comp & Pen Exam)

  - pull the DBQ: Hearing Loss & Tinnitus and review the medical opinion section - check for two theories of service-connection: 
  

Step 3 - Did the veteran provide a continuity statement tracing his symptoms over time?

• Yes - did the VA consider the statement in the Evidence Section of the Decision?

      - did the VA Examiner consider the statement? If no, appeal in HLR (DTA Error - Comp & Pen Exam)
  

• No - file Supplemental Claim with continuity statement

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@Ally